New Study Strengthens Evidence of the Connection Between Statin Use and Cataracts; But Any Risks Should be Weighed Against Benefits

Reported in the Canadian Journal of
Cardiology

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Philadelphia, PA, December 2, 2014

Few
classes of drugs have had such a transformative effect on the prevention of
cardiovascular disease (CVD) as have statins, prescribed to reduce total
cholesterol and low-density lipoprotein cholesterol. However, some clinicians
have ongoing concerns regarding the potential for lens opacities (cataracts) as
a result of statin use. In an article in the Canadian Journal of Cardiology, researchers report increased risk
for cataracts in patients treated with statins. An accompanying editorial
discusses the history of statins and positions this new study in the context of
conflicting results from previous analyses of purported adverse effects due to
statin use.

In previous studies the association between statin use and
cataracts has been inconsistent and controversial. The current study used data
from the British Columbia (BC) Ministry of Health databases from 2000-2007 and
the IMS LifeLink U.S. database from 2001-2011 to form two patient cohorts. The
BC cohort was composed of female and male patients; 162,501 cases were matched
with 650,004 controls. The IMS LifeLink cohort was comprised of males only,
aged 40-85; 45,065 cases were matched with 450,650 controls. Patients using
statins for more than a year prior to initial ophthalmology examination were
identified. Diagnosis and surgical management of cataracts were followed.

In the BC cohort, there was about a 27% increased risk of
developing cataracts requiring surgical intervention (Adjusted Risk Ratio, RR
=1.27). In the IMS cohort, the increased risk was only 7%, but still
statistically significant.

The adjusted RRs for long-term regular use of specific
statins in the BC cohort ranged from 1.14 to 1.42. In the IMS cohort, the
adjusted RRs for individual statins varied within a narrow range from 1.03 to
1.14. The investigators did not determine whether certain statins were worse
than others, but most confidence intervals overlapped suggesting a class
effect.

Lead investigator G.B. John Mancini, MD, of the Department
of Medicine, Faculty of Medicine, University of British Columbia, Vancouver,
Canada, states that, "Further assessment of the clinical impact of this
relationship is recommended, especially given increased statin use for primary
prevention of CVD and the importance of acceptable vision in old age where CVD
is common. Future studies addressing the possible underlying mechanisms to
explain this association are also warranted. However, because the RR is low and
because cataract surgery is both effective and well tolerated, this association
should be disclosed but not be considered a deterrent to use of statins when
warranted for CV risk reduction."

In an
accompanying editorial, Steven Gryn, MD, FRCPC, and Robert A. Hegele, MD,
FRCPC, of the Department of Medicine, Schulich School of Medicine and Dentistry,
Western University, London, Ontario, Canada, echo the need for balance.

They
write, "Any medication that has beneficial effects has potential adverse
effects; weighing the benefits against the risks is an integral part of the
informed consent process, and is central to any decision to initiate treatment.
Among patients who are at high CVD risk, like most of those seen by
cardiologists…the prevention of CVD, stroke, and their associated morbidity and
mortality vastly outweighs the risk of cataracts. Even among lower risk
patients, for whom the benefit-risk ratio is less dramatic, most patients would
still probably prefer having to undergo earlier non-life-threatening cataract
surgery over suffering a major vascular event."

In
any observational study, there can be unknown confounders that could introduce
bias. Both the study itself and the commentary note this weakness, but both
agree that this study, while not putting the issue to rest, does add
significantly to the accumulated knowledge about the statin-cataract
connection. However, as Dr. Hegele notes, "A randomized double-blinded
placebo-controlled clinical trial is the best way to mitigate confounding, and
such studies so far have shown no association of statins with cataracts."

Both appear in the Canadian
Journal of Cardiology, Volume 30, Issue 12 (December 2014), published by
Elsevier.

Full text of this article and editorial is available to
credentialed journalists upon request. Contact Eileen Leahy at +1 732 238 3628or cjcmedia@elsevier.com
to obtain copies. Journalists who wish to interview Dr. Mancini may contact him
directly at +1 604 875 5477 or mancini@mail.ubc.ca.
Contact Dr. Hegele at hegele@robarts.ca.

About the Canadian Journal of CardiologyThe Canadian Journal of Cardiology (www.onlinecjc.ca) is the official journal of
the Canadian Cardiovascular Society (www.ccs.ca).
It is a vehicle for the international dissemination of new knowledge in
cardiology and cardiovascular science, particularly serving as a major venue
for the results of Canadian cardiovascular research and Society guidelines. The
journal publishes original reports of clinical and basic research relevant to
cardiovascular medicine as well as editorials, review articles, case reports,
and papers on health outcomes, policy research, ethics, medical history, and
political issues affecting practice.

About the editor-in-chiefEditor-in-Chief Stanley Nattel, MD, is Paul-David Chair in
Cardiovascular Electrophysiology and Professor of Medicine at the University of
Montreal and Director of the Electrophysiology Research Program at the Montreal
Heart Institute Research Center.

About the Canadian
Cardiovascular SocietyThe Canadian Cardiovascular Society is the professional
association for Canadian cardiovascular physicians and scientists working to
promote cardiovascular health and care through knowledge translation, professional
development, and leadership in health policy. The CCS provides programs and
services to its 1900+ members and others in the cardiovascular community,
including guidelines for cardiovascular care, the annual Canadian
Cardiovascular Congress, and, with the Canadian Cardiovascular Academy,
programs for trainees. More information about the CCS and its activities can be
found at www.ccs.ca.

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